SHAKING UP THE WORLD OF PARKINSON S DISEASE
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1 SHAKING UP THE WORLD OF PARKINSON S DISEASE THE ROLE OF CHIROPRACTIC NEUROLOGY Ashkan Jalili, DC, DACNB, FACFN, FAAHP BC-Licensed Chiropractic Physician Associate Professor Clinical Neurology Fellow American College of Functional Neurology Diplomate American Board Chiropractic Neurology Fellow American Board of Metabolic Medicine
2 History of Functional Neurology Pioneered by Dr. Fredrick R Carrick Quintuple board-certified Chiropractic Neurologist, researcher and educator Founder of the Carrick Institute for Graduate Studies Former Director of Functional Neurology for the Carrick Brain Centers in Dallas, TX & Atlanta, GA Has assembled the world s largest database of Dynamic Computerized Posturographic outcomes related to TBI, neurodegenerative disease and movement disorders assembled from thousands of patients across the globe
3 History of Functional Neurology Published in Gait & Posture, Disability & Rehabilitation Frontiers in Public Health, Biomedical Science Instrumentation Journal of Biomechanics, Current Pharmacological Design, Brain Injury Neurorehabilitation, Clinical Neurophysiology, Int l Journal of Adolescent Medicine & Health, Journal of Alternative Medicine, Journal of Manipulative and Physiologic Therapeutics, Parkinsonism and related disorders, Mediterranean Journal of Physical and Rehabilitation Medicine Int l journal of Disability and Human Development.
4 What is Chiropractic Neurology? Doctor of Chiropractic or the equivalent that has taken 300 post-doctoral hours of coursework in functional neurology Must pass a rigorous written & performance exams required for Board certification by the ACNB We call these doctors Diplomates of the American Chiropractic Neurology Board (DACNB)
5 What is Chiropractic Neurology? We use the body and environment to assess the neuropathway weakness & dysfunctions. Examination & Assessment by a qualified Diplomate could take between 1 hour to 2 hours for certain conditions.
6 CORTEX Neostriatum - D2 GPe D STN GPi SN(r) SN(c) - + SC Pontine Nuc + Cb + Thalamus (VA and VL Nuclei) + Vest
7 MECHANISM A-Synuclein By-product of mitochondrial toxicityinduced cell death Lewy Body An accumulation of a- synuclein A-synuclein has an affinity for certain types of tissues Braak s staging
8 Chiropractic & Functional Neurology Doctor of Chiropractic Primary care trained in sport and spine injuries Functional Neurology A specialty in the chiropractic profession Plus additional sub-specialties Known for our effective techniques in joint manipulation Also provide rehabilitation & clinical nutrition Employ natural and conservative methods of care 3-4 years didactic and clinical training Must become board certified Trained in diagnosis & management of neurological disorders
9 Medical Neurologist vs Functional Neurologist? We are trained to diagnose and manage neurological disorders Only differ in the methods of treatment Offer non-surgical and drug-free methods of care Refer and co-manage care with medical specialists Neurological rehabilitation with novel applications
10 Testing/Diagnosis NO SINGLE WAY TO MAKE A POSITIVE DIAGNOSIS No blood test Imaging does not show anything until very late DaTscan may be able to show dopamine uptake deficiency UPDRS testing is the most accurate definitive diagnosis tool Good neurological exam provides a window to brain integrity and potential for improvement
11 THE Examination Comprehensive Medical History Physical & Neurological Examination Special Tests
12 How do we test neurological dysfunctions in Parkinson s? Structure Vs Function
13 FUNCTIONAL ASSESSMENT Vitals Balance Vestibular Function Eye Tracking Saccades Coordination Cognitive Assessment Physical Examination UPDRS
14 Common Tests Used to Measure Function Vestibular Assessment Video Oculography Gait Analysis Postural Stability Assessment
15 Common Tests Used to Measure Function RightEye Brain Assessment Neuro-Cognitive Assessment Muscle Strength and Reflexes Spinal & Joint Alignments
16 Goals of Examination Identify orthopedic musculoskeletal and peripheral nerve dysfunctions Test neurological systems independently and as integrated whole Objectively measure these functions
17 Video-Oculography Gold Standard for the evaluation of dizziness or balance disorder Objectively measures the reflexogenic and volitional visual systems controlling the eyes
18 Video-Oculography
19 Common Medical Tests to Measure Function Functional MRI and Spectroscopy PET Scans Electroencephalograms Neuropsychological Testing
20 MRI Tractography
21 SPECT Scan
22 What are these tests missing? Function al MRI s PET Scans Cognitiv e Testing
23 They fail to test How the brain responds to the environmental stimuli
24 Cannot Restore Function Medications
25 TRADITIONAL TREATMENT Levadopa Very effective at reducing tremor early, then effectiveness wears off Side effects: Dyskinesia Nausea Vomiting Hallucinations Paranoia Hypotension Deep Brain Stimulation Pallidotomy Or
26 EPIDEMIOLOGY #2 Most Common Neuro-degenerative Disorder Incidence: 20 per 100,000 Estimated 6600 New Cases Per Year Annual cost of medical service per PD patient can reach over to $120,000 Falls Tremor Suppression Depression Sleep disturbance Bladder and sexual dysfunction
27 PRESENTATIO N Tremor Bradykinesia Akinesia (Rigidity) Constipation Anosmia Hypothymia Fatigue Hypotension Imbalance Restless Legs Depression Stooping Posture Decreased Taste Irritability Shuffling Freezing Blurred Vision Cognitive Decline
28 RISK FACTORS Family History Toxins Trauma Smoking Age (55+) Sex (M>F) HX of Depression Testosterone/Estrogen Balance Folate (B9) Deficiency
29 UPDRS QUICK TESTS TRY THEM! Grading 0-4 Scale 0- Perfect, 1- Slight, 2- Mild, 3- Moderate, 4- Severe 1. Posture 1. Finger Tap 2. Rapid Pronation and Supination 3. Standing from Chair 2. Pull Test 3. Gait Assessment
30 UPDRS EARLY PARKINSONS
31 TRAILS MAKING TEST Trails A: 1-25 numbers randomly placed on a sheet of paper. Trails B: 1-13 Numbers randomly placed PLUS A-L letters randomly placed Time Trails A, then Time Trails B Higginson, C. I., Lanni, K., Sigvardt, K. a, & Disbrow, E. a. (2013). The contribution of trail making to the prediction of performance-based instrumental activities of daily living in Parkinson s disease without dementia. Journal of Clinical and Experimental Neuropsychology, 35(5),
32 TRAILS A
33 TRAILS B
34 TRAIL MAKING TESTS Switch with the person next to you
35 Therapies
36 Goals of Rehabilitation: NEUROPLASTICITY Strengthen and restore function to neurological systems Teach adaptive strategies for systems we cannot repair Diet and nutritional strategies to support cell metabolism and minimize risk of 2ndary issues
37 THE EQUINOX WELLNESS APPROACH
38 Remapping Visual Stability
39 VESTIBULAR THERAPY FOR PARKINSON S Vestibular rehabilitation (VR) is effective at reducing the symptoms and signs of Parkinson s Disease. VR can reduce incidence of falls VR can reduce frequencies of orthostatic hypotension VR can reduce square-wave jerks (SWJ) VR can improve spatial orientation VR can reduce tremor frequency and amplitude VR can reduce rigidity associated stiffness and pain Ahmet A, Karapolat H, Is customized vestibular rehabilitation effective in patients with Parkinson s, NeuroRehabilitation, vol. 37, no. 2, pp , 2015
40 VAGUS NERVE STIMULATION FOR PARKINSON S Vagus Nerve Stimulation (r-vns) is effective at reducing the anxiety and stress associated with Parkinson s Disease. r-vns can reduce Heart Palpitation r-vns can improve locomotion r-vns can improve Brain Blood Barrier integrity FARRAND, AQ; et al. Vagus nerve stimulation improves locomotion and neuronal populations in a model of Parkinson's disease. Brain Stimulation. United States, 10, 6, , Nov
41 THE EQUINOX WELLNESS APPROACH
42 THE EQUINOX WELLNESS APPROACH
43 SUMMARY Parkinson s is a prevalent neurodegenerative disorder First signs: Shoulder pain and stiffness, neck tightness, constipation, balance loss Tremor is the last sign to appear, and doesn t have to appear Therapies for PD should be directed towards cerebellar, vestibular, spinal, and eye movements. Specific areas can be triangulated through examination and testing. Functional Chiropractic Neurology Approach could offer a multi-modality approach to improve the QUALITY OF LIFE of PD patients.
44 Naturopathic Medicine Chiropractic Brain Fitness Rehabilitation Functional Neuro-Rehabilitation Metabolic Nutrition Management Pilates (Reformer & Mat)
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